ANZCOR-Guideline-12.1-Paediatric-Basic-Life-Support-PBLS ..., Lecture notes of Anatomy

Download ANZCOR-Guideline-12.1-Paediatric-Basic-Life-Support-PBLS ... and more Lecture notes Anatomy in PDF only on Docsity! ANZCOR Guideline 12.1 November 2021 Page 1 of 17 ANZCOR Guideline 12.1 – Paediatric Basic Life Support (PBLS) for health professionals Summary ANZCOR Guidelines 12.1 to 12.5 are provided to assist health professionals in the resuscitation of children. Differences from the adult and newborn guidelines reflect differences in the causes of cardiorespiratory arrest in, and anatomy and physiology of newborns, older infants, children and adults. These guidelines draw from Paediatric Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations1 the development of which included representation from ANZCOR. The 2020 European Resuscitation Council Paediatric Life Support guidelines2, 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Care3, previous Paediatric Life Support International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations4-6 statements and local practices have also been taken into account. ANZCOR Guideline 12.1 focuses on provision of paediatric basic life support (PBLS) by health professionals responsible for the care of infants and children working in healthcare settings (pre-hospital or hospital). It recognises the importance of immediate provision of BLS in the collapsed child while waiting for resuscitative equipment and drugs to arrive, which then allow provision of paediatric advanced life support (PALS) as outlined in ANZCOR guideline 12.2. This guideline should be read in conjunction with the other paediatric guidelines (ANZCOR Guidelines 12.2 to 12.5) and the general life support guidelines suitable for all age groups and environments (ANZCOR Guidelines 2 to 8). To whom does this guideline apply? This guideline applies to infants and children needing resuscitation but excludes resuscitation of newborns (see 12.1.2 for definitions). Who is the audience for this guideline? This guideline is intended for health professionals and those who respond to paediatric emergencies who have received training in PBLS practices. Lay rescuers and health professionals trained only in general basic life support (BLS) practices should refer to ANZCOR Guidelines 2 to 8 for general basic life support procedures suitable for all age groups. Untrained rescuers should call emergency services and follow instructions from emergency dispatchers. ANZCOR Guideline 12.1 November 2021 Page 2 of 17 Summary of Recommendations The Australian and New Zealand Committee on Resuscitation (ANZCOR) makes the following recommendations: 1. ANZCOR suggests that health professionals working in healthcare settings where they are responsible for the care of infants and children should be trained in PBLS. Lay persons and other health professionals should be trained in general BLS [Good Practice Statement] 2. ANZCOR recommends that rescuers provide ventilations and chest compressions for pediatric in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). If rescuers are unable or unwilling to provide ventilations, they should at least perform chest compressions [CoSTR 2015, strong recommendation, low-quality evidence]. 3. ANZCOR suggests that in infants and children who are unresponsive and not breathing normally, healthcare providers should begin CPR unless they can definitely palpate a pulse within 10 seconds [CoSTR 2010, LOE III]. 4. ANZCOR suggests that rescuers compress the chest by at least one third the anteroposterior dimension, or approximately 4 cm in an infant and 5cm in a child [CoSTR 2015, weak recommendation, very low-quality evidence]. Abbreviations Abbreviation Meaning/Phrase AED automated external defibrillator ALS advanced life support ANZCOR Australian and New Zealand Committee on Resuscitation ARC Australian Resuscitation Council BLS basic life support BVM bag-valve-mask CoSTR Consensus on Science with Treatment Recommendations CPR cardiopulmonary resuscitation ETT endotracheal tube IHCA in-hospital cardiac arrest ILCOR International Liaison Committee on Resuscitation IO intraosseus IV intravenous LMA laryngeal mask airway LOE Level of Evidence NZRC New Zealand Resuscitation Council OHCA out-of-hospital cardiac arrest PALS paediatric advanced life support PBLS paediatric basic life support PEA pulseless electrical activity PLS paediatric life support pVT pulseless ventricular tachycardia RCT randomised control trial ROSC return of spontaneous circulation SGA supraglottic airway VF ventricular fibrillation ANZCOR Guideline 12.1 November 2021 Page 5 of 17 4 Dangers: ensure safety of the rescuer and the child The personal safety of all individuals involved in resuscitation (patient and rescuers) is paramount. While there are very few reports of harm to rescuers during resuscitation, the following principles should apply: • Always check that the environment and patient surroundings are safe before proceeding (to prevent harm to the rescuer). • Personal protective equipment (PPE) should be used according to the perceived risk in the local setting. 5 Assessment of response The collapsed child's response to verbal and tactile stimuli should be assessed while also ensuring that this does not cause or aggravate any injury. This may include squeezing the shoulders firmly and asking loudly “Are you okay?” If the child responds (eg. by crying or moving), they should be left in a safe position and checked regularly while waiting for further help to arrive. If the child is unresponsive, the rescuer should move immediately onto the next step in the sequence and call for help. 6 Sending for help A single rescuer encountering an unwitnessed collapse of an infant or child should shout for help then start CPR immediately. If help has not arrived within 1 minute, the rescuer should go to get help. To minimise interruptions to CPR, it may be possible for the rescuer to carry the infant / small child with them while summoning help. When more than one rescuer is available, one rescuer should start resuscitation while the other summons assistance. A single first responder witnessing a sudden collapse (potential primary cardiac arrest) should prioritise obtaining help and then start CPR, as urgent defibrillation may be required [Good Practice Statement].5 7 Opening the airway Airway opening manoeuvres including backward head tilt with chin lift [jaw support] (Figures 1 & 2) or jaw thrust (Figures 3 & 4) may be used to optimise the position of the infant’s (neutral) or child’s (‘sniffing position’ ie. mild extension of head on neck and mild flexion of neck on shoulders) airway. Hyperextension of the neck should be avoided as it may cause airway obstruction, especially in small infants. If a neck injury is suspected, only jaw thrust should be used [Good Practice Statement] to avoid worsening the injury.5 ANZCOR Guideline 12.1 November 2021 Page 6 of 17 [Image courtesy of Children’s Health Queensland, licensed under CC BY] Figure 2: Head tilt with chin lift in a child (sniffing position) [Image courtesy of Children’s Health Queensland, licensed under CC BY] ANZCOR Guideline 12.1 November 2021 Page 7 of 17 Figure 3: Jaw thrust in an infant [Image courtesy of Children’s Health Queensland, licensed under CC BY] Figure 4: Jaw thrust in a child [Image courtesy of Children’s Health Queensland, licensed under CC BY] ANZCOR Guideline 12.1 November 2021 Page 10 of 17 Figure 6: Two-thumb technique in an infant [Image courtesy of Children’s Health Queensland, licensed under CC BY] Figure 7: Two-finger technique in infant [Image courtesy of Children’s Health Queensland, licensed under CC BY] ANZCOR Guideline 12.1 November 2021 Page 11 of 17 • Child: Chest compression can be performed with the ‘heel’ of one hand (Figure 8) or the two-handed technique (Figure 9) to achieve a compression depth of at least one third of the anterior-posterior (AP) diameter of the chest [Good Practice Statement]. There is insufficient evidence to make a recommendation for or against the need for a circumferential squeeze of the chest when performing the 2 thumb-encircling hands technique of external chest compression for infants.1 Whatever technique is employed, pressure over the ribs and abdominal viscera should be avoided. Approximately 50% of a compression cycle should be devoted to compression of the chest and 50% to relaxation to enable full recoil of the chest wall. Figure 8: One handed technique in a child [Image courtesy of Children’s Health Queensland, licensed under CC BY] ANZCOR Guideline 12.1 November 2021 Page 12 of 17 Figure 9: Two-handed techniques in a child [Image courtesy of Children’s Health Queensland, licensed under CC BY] ANZCOR Guideline 12.1 November 2021 Page 15 of 17 References 1. Maconochie IK, Aickin R, Hazinski MF, Atkins DL, Bingham R, Couto TB, Guerguerian AM, Nadkarni VM, Ng KC, Nuthall GA, Ong GYK, Reis AG, Schexnayder SM, Scholefield BR, Tijssen JA, Nolan JP, Morley PT, Van de Voorde P, Zaritsky AL, de Caen AR; Pediatric Life Support Collaborators. Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2020 Nov;156:A120-A155. 2. Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation. 2021 Apr;161:327-387. 3. Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL Jr, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, Meckler GD, Roberts KE, Sutton RM, Schexnayder SM; Pediatric Basic and Advanced Life Support Collaborators. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S469-S523. 4. Maconochie IK, de Caen AR, Aickin R, Atkins DL, Biarent D, Guerguerian AM, Kleinman ME, Kloeck DA, Meaney PA, Nadkarni VM, Ng KC, Nuthall G, Reis AG, Shimizu N, Tibballs J, Pintos RV. Part 6: Pediatric basic life support and pediatric advanced life support 2015 International Consensus on cardiopulmonary Resuscitation and emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015: 95: e147- e168. 5. de Caen AR, Kleinman ME, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D, On behalf of the Paediatric Basic and Advanced Life Support Chapter Collaborators. Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010;81:e213– e259. 6. Consensus on Resuscitation Science & Treatment Recommendations. Part 6, Paediatric basic and advanced life support. Resuscitation 2005; 67: 271-291. 7. Safranek DJ, Eisenberg MS, Larsen MP. The epidemiology of cardiac arrest in young adults. Ann Emerg Med 1992;21:1102–6. 8. Soar J, Maconochie I, Wyckoff MH, et al. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2019;145:95-150. 9. Children’s Hospital of Philadelphia. Quality of Pediatric Resuscitation in a Multicenter Collaborative (pediRES-Q). https://www.clinicaltrials.gov/ct2/show/NCT02708134. Updated April 10, 2019. Accessed August10,2020. ANZCOR Guideline 12.1 November 2021 Page 16 of 17 About this Guideline Search date/s ILCOR literature search details and dates are available on the CoSTR page of the ILCOR website (https://costr.ilcor.org) and the relevant CoSTR documents. Questions/PICOs: Are described in the CoSTR documents (https://costr.ilcor.org) Method: Mixed methods including ARC NHMRC methodology before 2017 and ILCOR GRADE methodology described in ILCOR publications since 2017. The guideline process includes involvement of stakeholders from member organisations of the ARC & NZRC, and peer review by members of the Australian and New Zealand Committee on Resuscitation (ANZCOR). Details of the guideline development process can be found on the ARC website at https://resus.org.au. Principal reviewers: Jason Acworth, Richard Aickin, Gabrielle Nuthall Main changes: This guideline is a new ANZCOR guideline focusing on provision of paediatric basic life support (PBLS) by health professionals responsible for the care of infants and children working in healthcare settings (pre-hospital or hospital). Approved: 13 November 2021 ANZCOR Guideline 12.1 November 2021 Page 17 of 17 Appendix 1: Paediatric Basic Life Support algorithm for trained health professionals (new ANZCOR algorithm to be released soon)